Café Recap: Postpartum Body Image

The Motherhood Café Presents: Postpartum Body Image

 

Panelists:

Brandy Wilson, PT, DPT – doctor of physical therapy who has been practicing in the Lynchburg area for over 12 years, and focuses on pelvic health.  Mom of 2, 9 and 6.

Trish McCoy Kessler, LPC – owner of Empower Counseling. Has been married for 10 years and has twin step daughters who are 17. Also a contractor with Prosperity Wellness, who treats eating disorders and body image issues in women and young girls. Loves working with women and empowering them to support each other in their journeys.

Erica: This is a sensitive topic that sneaks up on people and how emotional they can feel about these things. Our bodies go through a lot of changes during pregnancy and the postpartum period and so I just want you to feel comfortable with this discussion. At any point, we’d love you to chime in with your thoughts, experiences, or questions for our panelists. This morning is one that we’ve found in the past to be almost healing in its discussion. Sometimes we don’t realize the insecurities and feelings that we have where we are with our bodies and how we’re feeling as we transform from being a woman, to being a mother and a woman. Those changes are really difficult to talk about and to understand.  This isn’t really a conversation that’s going to fix anything, but at the same time sometimes talking about it in a group and getting support and that you’re truly not alone in these feelings and people that you might look at and say, “she’s really got it together” to hear that we’re also got our baggage and insecurities and feelings about how we look, act, and feel about our bodies and our health in general.  It’s helpful to know that we’re all struggling with things and hopefully that will make us that much more supportive of others to know everyone’s got their own stuff.

Erica: Health care disclaimer – local doctors and health care professionals are willing, advice is general . if you’re having a personal issue, please talk to your doctor and discuss your specific health care needs.  Take anything you hear here with a grain of salt and discuss with your personal doctors.

Erica to Audience: We’re going to start with an audience participation questions: How would you describe your body before having children or pregnancy in one word?

Audience Answers: winter ready, strong, nice, energetic, curvaceous, mine, toned, prettier than I realized, curvy, cooperative.

Erica to panel: do you feel that our culture supports women’s body images in general? Do you feel like we have a good idea of what the body is really supposed to look like?

Trish: I don’t think so. I think our culture has high expectations of what we should look like. Social media and advertisements make a false representation of what we should look like as a woman at any age and I think that’s a lot of pressure and it’s very unfair. I don’t think there’s a healthy view out there.

Erica: What about postpartum? Do you think that we have a realistic expectation for how we’re supposed to be when we’re caring for small children?

Trish: No, I don’t think so either. I think there again on TV and social media it’s all about how quick did she get her body back. That’s just unrealistic expectations. I think that the women on TV all have personal chefs and personal trainers. I think that they create a false representation of what a postpartum woman should look like.

Brandy agrees.

Erica to Brandy: What do you think is the most surprising change that women have during postpartum?

Brandy:  I think one of the things that I treat is the Diastasis issues – the abdominal don’t always go back to the way they were. Women will say that they have some ‘extra’ here or I tried a sit-up. One of the common exercises we’re taught is sit-ups and they can actually make Diastasis worse. We’ll try taping or show them manual exercises to strengthen the core. Folks come in to us having experienced when they sneeze or cough they leak or dribble some and they think ‘oh well I’ve had a baby, its normal’. Making sure everything’s working as well as it should. 

Erica to Trish – What do you think some of the most common mental changes are after having a baby or pregnancy?

Trish:  With the women I work with, they’re sometimes very anxious and depressed. They feel out of control. If it’s their first child, it’s the fear of the unknown, fear of body changes, and what to expect. We really work on some of these symptoms, loss of sleep and any distortions they have of what is realistic or what their bodies should be doing. I work with them to have a new normal of what it’s doing while they’re pregnant and after.

Erica: Why do you think that we’re so critical of our bodies? Why do we compare so much? Is it because of what we see all the time? Why do we have these expectations of how we’re supposed to look postpartum?

Trish: I think that the expectations and standards are just higher. I thought about my own mom – she’s not a size 2, but she’s the most beautiful woman I’ve ever seen. She always exemplifies self confidence and I never had this expectation, but as I got older and social media makes it harder than what it was years ago.

Erica: I sometimes am shocked at women’s experiences and what others have said to them postpartum. It hurts a little when your child says, “Oh, Mommy! You’re going to have another baby!” when you’re not. That’s a child and it’s innocent, but we’ve heard stories of amazingly insensitive things that have been said. It increases the feeling that you should hide yourself during that time.

Brandy: I myself have been struggling since my daughter. I’m a lot smaller now than I was a few months ago from exercising and being more cautious with food. You may have a long way to go, but it helps to remember where you’ve come from. Positive feedback from others is really helpful.

Erica asks the audience to share their experiences.

Audience:  My husband reminded me that it took 9 months for my body to make these changes, so it’s not going to go back overnight.

Audience: I was shopping for a nursing bra at three stores and the clerks at two stores asked me when I was due. My son was right there with me and he’s 10 months old.

Erica to Audience: Have any of you ever felt “pressured” to get your body looking a certain way, either by your significant other or mother?

Audience: My sister kept asking me when I would be ready to go bridesmaid dress shopping. I said, “I’m ready now.”

Audience: I’ve had friends and family offer to buy me a gym membership to help me get my body back. I know they’re just trying to help but it was annoying.

Audience: I haven’t really had anyone say anything other than encouraging things to me, but I can relate to the social media aspect; especially with people trying to sell products. They show a picture of a women a week post partum and then again at 6 weeks postpartum and it’s a drastic difference. It puts those images in front of us and makes us think that’s what’s normal when it isn’t.

Erica: Images are really powerful. There is a sting that comes when someone is speaking to you directly, but the constant visual of what we’re supposed to look like is the thing that sticks with you. It’s difficult to adjust to your new body – it’s something that many women struggle with, no matter what their body looks like before or after.

There’s a really powerful blog post that’s circulating now that’s about being in the picture with your children. Twenty years from now when your children are looking back at pictures, they’re looking to see you. They want to see what we looked like when we were parenting them as a three-year-old. It’s something that we need to remember – our children love us and they’re going to want to see us again in the future, too.

Erica to Brandy – Can you talk a little more about the things women come to you for help with?

Brandy: Diastasis is where your abdominal muscles stretch during pregnancy and the lining separates. If you’re noticing a hernia in that area, we can do corrective exercises and get those muscles back together and strengthen your core.

Erica: Is that something you notice right away or can it be fixed years after pregnancy?

Brandy: It can be fixed right away. If you’re having issues or a lot of pain right after delivery or if it’s years later, it’s certainly worth coming in and getting back on track.

Erica: Let’s talk about the difference types of incontinence women deal with.  I read an article on the history of Poise pads and it talked about how more women are using them in their thirties and forties. 

Brandy:  There are two types of incontinence: urinary and fecal. With urinary there’s stress incontinence – when you’re sneezing, or lifting. There’s urge incontinence when there’s a very strong urge. It can hit you and there’s no delaying it. It’s the process of standing up to go to the bathroom and everything empties. There’s also mixed incontinence, which is when you experience a mix of both. We look at see what’s your bladder doing with a log of what you’re drinking and how often you’re going, talking a little on the normal bladder – your normal bladder holds about 2 cups of urine and going is about 6-8 times throughout the day and night, and we should be able to sleep all night without it waking us up to empty. You should be going every 2-4 hours. If you notice with your bladder log that you’re going more than normal, those are things where your bladder isn’t working as it should. There’s also fecal incontinence – certainly with ladies who have had a 3rd or 4th degree tear with delivery. It can happen immediately or 10 to 15 years after. It’s a matter of seeing what your muscles are doing, doing behavioral modifications to get you back on track.

Audience question: Is the frequency of urination that you mentioned the same for during pregnancy? I find myself waking several times a night to empty my bladder.

Brandy: That’s what’s normal not during pregnancy. During pregnancy it might be a little more.  The baby pushing on the bladder can increase the sense of urgency. We see ladies during pregnancy who have a lot of pressure - it’s utilizing the taping to give support and help them through their pregnancy.

Erica to Trish: Let’s talk about some of the things you see women coming in for. What are the things you suggest women do? What are some things that are helpful for women to do at home of they’re not ready for therapy?

Trish: Some of the things you can do at home are to realize what your trigger symptoms are, what’s causing your anxiety or depression. There are relaxation techniques that you can do. You can do deep breathing, yoga. If you’re ready or feel like you need to, I work with women with addressing anxiety and identifying depression. Managing coping skills and making sure their support system is in place.

Erica: You’ve mentioned you work with women are experiencing eating disorders. What happens when someone who is dealing with eating disorders gets pregnant and then deals with postpartum. How is it different?

Trish: I think it’s more extreme – you never really get past eating disorders. If you have an eating disorder prior to becoming pregnant, reach out to your physician to help. Nutrition is so important during pregnancy.

Erica on audience question: How can we accept that our breasts really change during pregnancy and nursing? Is there anything you can do besides plastic surgery?

Brandy – Muscle-wise, you can do more of your pec-major and -minor exercises to help posture and give you support and stabilization.

Erica: Do not discount the importance of proper garment fitting. Most women are not wearing the right size bra. If you’ve gone through pregnancy and postpartum and you’re wearing the same bra or if you’re been wearing the same bra for years, it’s probably time to invest. It can make an amazing difference.

Erica: What surprised you about your own feelings postpartum?

Brandy: Prior to my first child, I had my plan. I was going to nurse. I was going to take my lunch break to nurse. I tried and he wouldn’t latch. I went to the lactation consultants. I was in tears, my husband was in tears. I wasn’t worried about my body, but I thought it was going to be a smooth transition.

Erica: For the next part, we had one the moms here take some pictures of some of the other moms. These are some pictures of women here who were willing to be photographed in their postpartum bodies.

Audience Exercise: Make a list of 5 things you like and think are important about yourself. List 10 things that you value about people in your life that you’re closest to.

Erica: Mostly we just want you to look at those and see how many of them are about your physical appearance or are about other things. Whether it be their personality, or strength in character. Really look at what you value.

Trish: Erica, that’s one of the things when I work with women is to change their perceptions and identify all of the positive things. Sometimes we don’t take time for ourselves.

Erica: What do you think women should discuss more openly? How can we be more supportive?

Trish: Stop being so critical of ourselves and other women. Be a great role model for our children to help the next generation coming up to not be as critical.

Erica: Brandy, if women here are feeling like they want to get back in shape, to feel better about themselves. Where do they start?

Brandy: Start off with a walking program. Five minutes here and there add up and can make a difference.

Erica: At the beginning we talked about how we felt about our bodies before having children. Now, describe your body and yourself after you’ve had children. How would you describe yourself?

Audience: tired, phenomenal princesses of power, confident, proud, sensitive, beautiful, stronger.

Erica: To close, I would like each of you to take one last piece of paper and write a compliment to the woman on your right. It doesn’t need to be about her body; could be about her mothering, her smile, something you’ve noticed while we’ve sat here. Let’s not let a single woman sneak out of here unnoticed. You each are all beautiful.

Cafe Recap: Sex, Love and Other Things After Baby

Welcome to one of our favorite topics! We were so pleased to have two health care providers willing to help us shed some light on common issues that are all too often kept in the dark. We welcomed Katie Page, CNM, and Dr. John Pierce, MD to our cafe' morning on February 8, 2016.

Our bodies go through a number of changes during pregnancy and birth. We spent some time talking about what to expect, what’s “normal” after baby and what are signs of possible problems. Too often women feel uncomfortable discussing these topics, but our sexual health is important, which is why we do this cafe' each year! Continue reading for a recap of our February cafe entitled: "Sex, Love and Other Things after Baby."

Q: Could you give us a brief description of what our most delicate, feminine parts of our bodies have gone through in the birth experience, etc.? 

Katie shared an excellent graphic with us that detailed the variety of ways in which our vaginal area can be affected during and after birth. From minor swelling to 4th degree tears...some of the more severe tears were hard to even think about...but it showed that there are wide variations of 'normal', and healing will take different amounts of time for each woman. Also, our pelvic floor muscles will be weaker than before and need to strengthened. 

Q: I’m curious as to your thoughts why a morning on this topic is even necessary? What have you seen women in the postnatal period (or later) struggle to grasp and understand regarding sex after having a baby?

John: It's a topic that needs discussing because women (and their partners!) need to understand, from a medical perspective, what is going on physically and emotionally in a woman's body after giving birth. He has actually walked in to a hospital room to find couples having sex after just having had a baby (!) ... while each woman's body is different and the timeframe will be different, that's definitely not recommended, and we need to understand why. Also, it's important relationally...for true intimacy and depth of relationship. 

Katie: It's important physically, yes, but also mentally and emotionally...there are so many changes that happen in pregnancy and birth. Also, a birth experience, whether positive or negative, can dramatically impact sex.

Q: Our bodies physically undergo quite the transformation, but often women describe changes in their feelings about their partner and sex. What types of changes did your heart and mind undergo after becoming a mother? Did you feel the same? Different?

Katie: It was a big change, however, some of that is also cultural. We tend to be over-committed as a culture, and let things take over our whole life to the detriment of other areas of our life. I'm still ME. I'm a mother, but also all of these other things that I was before too...recognizing that this a new part of us, and a BIG PART of us, but not letting go of who we are as a person. That being said, there are lots of big emotions and big feelings that come and go after becoming a mother, and it is important to talk about them with your partner. It will take a lot of time, practice and patience, but it's worth it. 

Q: Why is there a 6 week freeze on intercourse? What is going on in a woman’s body during this time? 

John: It's different for everyone (although 2 days IS too short! see above). There is trauma, even in a good delivery. Muscles and nerves are stretched and nerves take longer to heal. To check how muscles are, you can 1) start to urinate then stop the stream or 2) put 1 or 2 fingers inside vagina and tighten, then release. This will help give you an idea of how well your muscles are healing (although the 6 week check is designed for your doctor to check on these things). If there has been a bad tear, it could be more than 6 weeks; if things are going smoothly, it could be as little as 3-4 weeks. Overall, take it slowly. There will probably be some vaginal dryness (use lubricant...even just some olive oil!) but there should not be pain.

Katie: There are some exercises that you can do to help...what John already mentioned are good things to do; if there is pain involved, you are not ready for sex. The 6 week check up is checking so much more than just the vagina; it's testing for soreness or issues in a host of other surrounding muscle groups as well. Kegels are good, but need to make sure you're both contracting AND relaxing...you need to be able to do both. Also, focus on good GENERAL health. When you feel better about yourself, you'll feel better about sex. Don't expect the baby weight to disappear in those 6 weeks, but give yourself some grace; be patient. Take time and space to take care of yourself, and you'll be more content and happy, which will have a positive impact on sex.

Q: What is 'normal' when it comes to having sex/frequency after baby? (note: when polled, the average time for the audience to have sex after baby was 'before 6 months'.)

Katie: There is such a wide range of normal! For some couples, sex everyday was normal before, but for others, sex once/month could be healthy and functional. Don't compare. If you and your partner are both comfortable, it's healthy. We as women tend to need to be aroused first, while for men, they think about it first and are then aroused. Add in abdominal/vaginal changes, and it's a lot! Talk about expectations and desires...both of you need to work together to find what works for your specific relationship.

John: Be aware of 'creeping separateness'. Where you slowly are drifting apart but don't really realize it. It will take time to figure out, but work at it as a team and together. It's important to continue to date one another and set aside time to talk as a couple about plans/dreams/desires for yourself, your relationship and your family. 

Q: So many say that the “best” foreplay is seeing their partner doing the dishes! But seriously, what types of foreplay would you recommend? Is foreplay even necessary?

John: Referred to the phrase, "Men are like a frying pan, women are like a crockpot." In essence, if things are going well outside the bedroom for a woman, things won't get well inside the bedroom either. (editor's note: it was at this moment that we all wanted to record Dr. Pierce's insights and play them in the background of our homes.) Men NEED to talk about expectations too! Learn each other's 'love languages'...how does the other one best receive love? Is it by doing the dishes for them? Then do them! Is it by saying 'I'll take care of the kids, you go take a bath'? Then do that! Recognize that this is a season, and there may not be a lot of time for foreplay, but if you can try to put each other's needs first when you are able, the sex will come a lot easier. Also, lube. Again the lube...it can be your best friend during this season!

Q: How have you personally maintained and found time for a healthy sex life? Any tricks of the trade? Has anyone ever shared any particular pearls of wisdom that stick with you?

Katie: When they're a newborn and can't roll yet, it's a lot easier...just put them somewhere safe: the floor, their crib, wherever, and you're good to go! :) For a while...schedule it. We schedule everything else in our lives, why NOT this?! After a while, you'll start just finding the time and it will become a new rhythm. (although, she noted, our short maternity leaves do not help in this area...we barely have time to adjust!) Schedule parental 'nights off' for each other, split up chores and tasks...use an adult chore chart! Also, if it's scheduled in, it helps your partner to know and anticipate taking over some parental duties so that you can prepare.

John: We need margin for time and space. Focus on your family; personally he and his wife made a clear boundary: the parents were prioritized and it was not all about the kids. Also, use 'code words' for sex, so you can talk and plan when you have a few minutes, even if the kids are around! Example: I'd like to go to a restaurant. Fast food, not gourmet. (get it? wink, wink.) Or having a cue, like him coming home to a lit candle means that you're thinking about it and in the mood...but also realizing that sometimes the best-laid plans can still go awry, and the baby will start crying, need to nurse, etc. Remember that it's not just the act of SEX, but how we promote acts of LOVE.

And that is a great way to end! If you have additional questions or feel you'd like more info on something we touched on here, please feel free to contact our blog editor at ameador@themotherhoodcollective.org and we'll help you find the answers you need!

Café Recap: Introducing Baby to Learning

Our panelists: Rachel Gagen (Pediatrician & IBCLC), Scott Rankins (Speech-Language Pathologist), Kevin Van Wynsberg (Department Chair for the Center for Counseling and Family Studies at LU), and our moderator, Lauren Barnes. Today’s topic, while primarily focused on babies in their first year, also spanned to toddlers, and older children as well. We covered important topics such as milestones, learning styles, and feeding.

Milestones

Milestones seem to always be in the back of a parent’s mind. They serve as a measurement and comparison tool between your child and every other child of his or her age. Is my child developing normally? Does his lack of speech present a concern? Should she have more hair at this point? Is his head too big? All of these are valid concerns, but Gagen, Rankins, and Van Wynsburg gave several reasons why worrying about milestones can add unnecessary pressure and anxiety to parents.

Gagen explained that you should “compare your baby to your baby.” The milestones are there to help parents and doctors make sure everything is progressing normally. However, she noted that while some babies are exactly where they need to be, others are either a few months behind or a few months ahead, and that’s okay! The best way to measure your child’s progress and development is to look at where he or she was a month ago, two months ago, and so on. Rankins explained the importance of looking at a child holistically. As a Speech-Language Pathologist, Rankins sees varying levels of communication difficulties, and the milestone measurement serves as a generalization by which he can start asking questions and making predictions. He explained that the range can be about 3-4 months on either side, so focusing too heavily on the specific milestone for a specific age can be inaccurate. Similarly, Van Wynsburg commented that ten fingers and ten toes is a much easier “normal” measurement than what is “normal” socially, emotionally, and kinesthetically with infants. He argued that there are so many great tools out there available to parents—of which the milestones are one—but we don’t want the tools to take the place of what is most important, interacting with and helping your child learn about him or herself and his or her environment.

Learning Styles

Learning styles of today are certainly different than they were twenty-five years ago. Today, we have iPads and cell phones and toys that light up and talk back. Rankins commented that one of the down sides to these battery-operated toys is that children are not presented with the challenge of using their imaginations as they are with less tech-centered toys. He stated, “Interaction is how we learn how to communicate effectively.” And with toys that do the talking for us or Baby Einstein videos that replace child-parent interaction, children may lose out on valuable communication building. Both Gagen and Rankins agree that children don’t need much to entertain themselves or to learn through exploration. Gagen joked that whatever you give your child for his or her first birthday, you can simply rewrap it again for his or her second.

Feeding, Bottles, and Silverware

A large part of learning for both children and parents deals with feeding. Regardless of whether your child is breastfed or bottle-fed, each child must learn how to eat solid foods eventually. Both Gagen and Rankins explained that it is important to begin some sort of solid foods at 6 months in order to prevent future allergies, but what is equally as important is letting your children experiment with and get messy with their food. The sensory experience of eating is valuable for your children on several levels. They are able to feel the different textures, smell the different scents, and taste the different flavors.

Parents may not realize how pivotal their role is in a feeding situation. Van Wynsburg advised that when feeding your child, you should make sure to keep your face happy or neutral. If you go into a meal with an anxious or worried face, your child will pick up on your hesitancy. This is one of the reasons why allowing your child to have a messy face is crucial. It allows the child to explore without interruption from a napkin or face wipe. When asked about children who cannot handle a mess on their faces, both Gagen and Rankins explained that if you freak out about the mess on their face, then they will freak out. If you have a child who cannot handle food on his or her face, talk about it. Use it as a learning tool. Ask them about the different textures, temperatures, and colors. You can even add some sweet potato puree to your chin! They will likely become distracted by the interaction or see the mess as a positive aspect of the food experience.

While babies are encouraged to use bottles and pacifiers up until 12 months, any bottle or pacifier use after that can have negative effects. The panelists explained that bottles and pacifiers can become ingrained habits that will be more difficult to break the older your baby gets. Some of the negative effects include future orthodontic issues or mouth disfigurement and susceptibility to ear infections.

Silverware can provide another learning obstacle, but Rankins mentioned that you can introduce silverware as early as eight months. At that age, babies will immediately bring the spoon to their mouths, so this can start the process fairly easily. However, children will not be able to use solely silverware until about three- or four-years-old, so let it be part of the learning experience and not something you force.

While we briefly touched on potty-training, that is a topic for another time! Thank you to our amazing panelists for your wisdom and insight!

Café Recap: Accepting Your Birth

Our panelists: Erin Baird (CNM), Lauren Barnes, Kerri Bond, Kirstin Magnuson (Marriage and Family Therapist) and our moderator, Erica Wolfe. Birth is transformative. We meet women every day who could describe their births from thirty years ago in vivid detail. Part of our mission here at The Motherhood Collective is to transform the culture of fear surrounding birth, we strive to encourage women to educate themselves and create a supportive environment for birth. But the truth is, we all must enter birth with open hands. The stories we would write for ourselves are not always the stories that make us the strongest mothers for our children.

And friends, while birth is transformative -- it is truly only the beginning.

Kerri's birth experience started with a normal pregnancy, but was scheduled for an induction due to high blood pressure. She planned for a natural birth and expected everything to go quickly and smoothly. After several days with no progress, she eventually had an epidural and was sent to the OR due to cord prolapse. Erin delivered her baby and rode with her to the ER holding the cord the whole time. Erin explains that for the cord to be delivered first is very rare, and once the cord is delivered it cannot be put back. At only a few centimeters dilated the cord will be compressed by contractions and the baby's head during labor, which cuts off the baby's access to the placenta in the hours before birth. At nine centimeters the cord can sometimes be delivered with the head, but earlier in labor (such as Kerri's situation) this is not an option.

Erin has had many birth experiences (four), ranging from emergency vacuum to a natural birth. As an educated midwife she had expectations for her births and her abilities that were not met. When birth does not go the way we planned, it can be a difficult thing to come to terms with. Kirstin is inclined to listen to these stories without making suggestions- just being a safe and supportive person for them to tell their story to can be helpful. At six week appointments, Erin makes it a point to debrief with her patients to help them process their birth experience. Feelings of failure and depression are not uncommon and should be talked about and handled professionally in order to overcome them.

Sometimes we get so caught up on the negative aspects of our birth experience that we forget the positives; the times we were strong and the things that went right can get buried under the things we are unhappy about. One audience member found peace in writing the very worst of her birth experience down in the back of a notebook. She could be honest and not hold back, as opposed to when she talked about it with others. Talking with others that have had a hard time accepting their birth can also help by putting things in perspective and moving the feelings of anger into something more productive.

It is important to remember that trauma is defined by the person who experiences it. Sometimes a patient has a relatively normal birth but still feels traumatized by the experience. We often try so hard to prepare for birth but it is something that is ultimately out of our control. Physical and emotional trauma can both have lasting impacts. Sometimes it isn't until later that we realize that our birth was not ideal; one audience member saw in hindsight with her subsequent births that the care she received for her first birth was really not what it should have been.

More than 25% of women describe their births as traumatic. To identify this in our friends and other mothers, there are signs we can look for. "I didn't do well" (or variations of) is a phrase that Erin hears and knows is not a healthy outlook. Without meeting all of the PTSD symptoms, women can still have a negative or distorted view of their birth. Nightmares, flashbacks, avoiding certain triggers or not talking about the birth, difficulty sleeping, hyper-vigilance, panic attacks and overwhelming stress are all signs that a woman is struggling to deal with her birth experience. If a new mother is not sleeping because she is fixated on her birth (as opposed to the normal newborn sleep struggles), she should find someone to talk to. Talking to a counselor, who is a disconnected person that is not otherwise involved in your life, can help you work through your feelings without judgement. Trouble processing your birth experience can lead to postpartum depression, especially if you do not find a safe outlet for sharing your story.

Mothers are not the only ones traumatized by birth- fathers can also have a difficult time processing their role in the birth. Watching helplessly is not a good feeling and can leave them quite upset by the experience. Checking in with your partner and discussing the birth in the weeks following can be very helpful for both of you. A doula can also be helpful for both partners, as they can keep you both informed and provide support for each of you.

Postpartum depression can present in various ways; anxiety, mania or an obsession with the baby or birth are also unhealthy. It can present as obsessive-compulsive disorder, or euphoria on the other end of the spectrum. Euphoria is often followed by a crash, especially if there was traumatic experience that is being denied. It is important to remember that accepting medication is not a weakness but a step in the direction of normalcy and getting your life back on track.

Sometimes birth challenges come down to simple choices, but sometimes they do not not. When asked, “What advice would you give pregnant women regarding giving birth confidently in the future?” Katie Rohs from PATTCh.org says, “Empower yourself with your own knowledge, and choose a care provider that you trust deeply...Don’t be afraid to seek out different care if your needs aren’t being met.” It is important to recognize that we did not make an incorrect choice that lead us to an unwanted outcome.

Some births go according to plan, and some patients are not as deeply affected when they don't. But if you do have negative feelings about your birth experience or the role you played in the outcome, speak up and find support. The Motherhood Collective (and our Grief and PPMD groups) as well as other local and national resources are available to you.

Café Recap: Handling Transitions

Our panelists: Josie Olson (Play Therapist), Loan Kline (Pediatrician) and Katherine Brown (Early Learning Center Director), and our moderator, Lauren Barnes. We often talk about bellies and babies here at the Collective, but today's topic includes issues specific to our two- to four-year-old children. Potty training, big kid beds, and limits– there are lots of unique challenges within this age range.

Milestones

Loan focuses mostly on gross motor skills in the first year and language skills during the second year. Katherine sees children develop at various paces; her organization does an assessment based on each child instead of comparing children to each other. They use the assessments, along with parents' assessments, to help the children achieve goals. While it can be tempting to push children to reach certain milestones, that behavior in parents can be harmful. Josie recommends setting them up to achieve these milestones by creating an environment that will help them to get there on their own.

Potty Training

Potty training is a big milestone that parents are often anxious to achieve sooner than later. Loan says that you can start before two, but most kids are not going to be ready by age two. Signs of readiness are the ability to follow two step commands ("take your pants off and sit on the potty"), recognizing that they have gone (if they will continue to play in wet underwear then they don't have this awareness yet), recognizing that they need to go before they go, and a willingness to sit on the potty. A potty in the car can be a solution for transitioning from at home potty training to going out in the world. Fear during potty training is another hurdle some children need to overcome. Josie recommends validating their fears; having them draw or use puppets to show what exactly they're afraid of, and then helping them find a solution (like picking out a new toddler potty).

Sometimes transitions and milestones overlap. Having a second child can make parents want to potty train their first child before they're ready. Reading their cues and waiting until they're ready is usually the better option for both parent and child. An audience member suggests that two babies in diapers is much easier than struggling to potty train a toddler that isn't ready, while juggling a newborn as well.

Sleep

According the National Sleep Foundation, toddlers (1-2 years) need about 11-14 hours of sleep in a 24-hour period. When they reach about 18 months of age their naptimes will decrease to once a day lasting about one to three hours. Naps should not occur too close to bedtime as they may delay sleep at night. Many toddlers experience sleep problems including resisting going to bed and nighttime awakenings. Nighttime fears and nightmares are also common. Many factors can lead to sleep problems. Toddlers' drive for independence and an increase in their motor, cognitive and social abilities can interfere with sleep. In addition, their ability to get out of bed, separation anxiety, the need for autonomy and the development of the child's imagination can lead to sleep problems. Daytime sleepiness and behavior problems may signal poor sleep or a sleep problem.

Loan finds that these guidelines are true for most toddlers. Toddlers that do well with less sleep usually have a parent that also functions well on fewer hours of sleep than average. One indicator that they are not getting enough sleep is growth; the growth hormone is released during sleep so if a child is not growing well sleep may be the issue.

Transitioning out of the crib usually happens around two to three years of age. Some children are ready earlier (if your toddler can climb out of the crib it is time to move them). For active/climbing children, consider taking anything dangerous or furniture that they can climb out of the room. Some parents stay in the room after bedtime to enforce the idea of staying in bed for the first few nights; do not engage with the child, simply direct them back to bed immediately.

There are various reasons that children have trouble with bedtime. Some children have trouble relaxing their bodies; you can gently massage or rub their back until you hear their breathing change and they are ready for sleep. Remember that with any transition it can take your child a few days, or longer, to get used to the new routine. Consistency will help them adapt easier. If children are afraid you can help them realize their monsters (with drawing or clay) and discuss how to overcome that fear (with "boogie monster" spray, for example).

Responsibilities

Josie says to never do for your kids what they can do for themselves. Empower them to help and take care of themselves and their things. Model how to do things, give them the tools to help, and they will join in and eventually be able to do things themselves. Loan says a sense of responsibility is very important. Her office provides a list of age-appropriate chores for parents. Singing or making it into a game can help ("let's put all the blue blocks away first"). If a toddler fails once and then gives up, you can help them gradually learn to do it themselves. You can break the task into smaller steps to help it seem more manageable and provide more opportunities for success. Remind them of past successes, and talk with them about problem solving.

Behavior

Emotional regulation for toddlers is a process. 18 months to three years is a period of negativity. They delight in refusing a request because it is a new-found power for them. This is also a time they are testing boundaries and seeing what they can do. Give them choices to help avoid the constant "no". Let them make small choices to help them feel empowered, and stick to routines. Tell them when there is going to be a change of plans and help them prepare for new situations.

Shaming your child is never helpful. You can point out bad behavior but reiterate that the child is not bad. Use positive language to tell them what to do, instead of using negative language to tell them what not to do ("walk, please" as opposed to "stop running"). Use books to help illustrate good and bad behavior. Katherine has classroom meetings to discuss problems before they arise. She lets the children talk to each other to help them learn from each other. Discipline is an ongoing process, but with young children redirection and distraction is often the preferred method. If you can get them to stop a negative behavior without a tantrum or fight, they are going to be happier and learn good behavior from your positive reinforcement. When it come to matters of safety you can still give options ("you can hold my hand or I can carry you in the street"), but do not negotiate anything beyond what is safe for the child.

New Siblings

The best time for a second or subsequent child depends on you and your family. Physically a woman's body is fully recovered from childbirth after two years. Some suggest that a three year old is much more capable of handling a new sibling than a two year old, as they are more independent. Our panelists suggest that you start preparing your child early for the arrival of a new baby. Use age-appropriate books and videos to introduce them to the idea (picture books are helpful for younger children). Getting them a baby doll of their own to take care of can be helpful, as young children like to imitate our behaviors. Talk to your child about what it means to be a sibling, and continue to promote the idea that siblings are the very best friends. Allow them to hold onto some "baby" things (like their special blankie, for example). When it comes to room sharing, experienced moms say that each child will get used to it and their sleep patterns will adjust as needed.

What a lot of helpful information! Thank you to our panelists for providing so much great advice. If there is anything that was not addressed in this article, feel free to leave us a comment here or on The Motherhood Collective facebook page.

Café Recap: Choosing A Maternity Care Provider

  Our panelists: Katie Page (CNM at CMG Women's Center) and Debbie Perdew (DONA), and our moderator, Lauren Barnes.

As mothers, choosing a Maternal Care Provider can be one of the most important decisions we make. Today our goal is not to prove one care provider’s skills better than another, but rather, to get you thinking about your personality, your needs, your desires, and provide you with some resources so that you can choose the best care provider for you! All women are different and each of us have different needs. You are each deserving of respect regarding your choices. My hope is that today you would see that there are choices that are right for each woman. We are not a “one size fits all group.”

Choices in Childbirth is a great resource for this topic, and shares this advice, "Once you’ve identified what’s important to you, you’ll be able to clearly communicate your wishes and choose a care provider and birth environment that will respect and honor your choices.”  They suggest a 3-step process for choosing a care provider:

Step 1: Understand Your Provider’s Philosophy (and Make Sure it Matches Yours)

Step 2: Reflect on Your Experiences so Far, Watch Out for Red Flags and Trust Your Instincts

Step 3: Ask Around and Compare Your Options

Care provider options are generally Physician, CNM (Certified Nurse-Midwife),CM (Certified Midwife), and CPM (Certified Professional Midwife). The majority of physicians who care for women and deliver babies are OB-GYN (Obstetricians/Gynecologists), who specialize in women's care. Some physicians are family doctors who care for the whole family and also deliver babies. Physicians attend births in a hospital. CNMs and CMs are educated with master or doctoral degrees and are certified by the same board (American Midwifery Certification Board). CNMs are trained first as nurses and then as midwives (CMs are not nurses before their midwife training). CMs are not licensed to practice in VA. Most CNMs attend births in hospitals, though some do attend birth center and/or home births as well. CPMs are certified by a different organization (North American Registry of Midwives) and are licensed in some states (including Virginia). CPMs are educated in schools of midwifery or through apprenticeship and are specifically trained in out of hospital birth. In Virginia, CNMs are licensed to prescribe a wide variety of medications, while CPMs are not allowed to prescribe. CPMs do, however, utilize a variety of herbal medicines to meet some needs of their clients. Direct-Entry or "lay" midwives are another type, and are not certified nationally, nor licensed or regulated by the state. Their training varies, though most are apprentice-trained.

Here are two models of care two consider:

a) “... the belief that birth can have potentially pathological outcomes and that medical and technological management reduces the likelihood of these outcomes.”

b) “...the belief that for healthy women, birth is a normal life process that results in healthy outcomes and is best left alone unless a complication arises.”

Knowing which (or both) of these models sits well with you can help you to choose an appropriate care provider. Debbie recommends that decision making during labor is best avoided. Think about your options beforehand and discuss them with your care provider, so that you are going into labor with as few last minute decisions as possible. As a doula, Debbie says that her role is not a care giver and that patients should trust and listen to the care givers they have chosen to have on their team.

One common suggestion is to interview your care provider. Katie says that we should feel comfortable in doing this. She says that there is a spectrum of types of care, from passive to active. Taking a very passive role would be trusting your provider to make all choices for you, while an very active role would mean making all of your own choices; in the middle is teamwork between patient and provider. Physicians and midwives alike fall at various places within the spectrum.

Sometimes it is helpful to remember that your care provider really is there to care for you. When we have questions or consider making decisions that go against what our care provider might recommend we often meet with resistance. This can be difficult as a patient, but if we remember that their job and their passion is our safety, we can sit and have reasonable discussions to pick the best path of care.

Café Recap: Homemade Baby Food

Our chefs: Melissa Kan, Kerissa Williams, and Laura Walker, and our moderator: Erica Wolfe.

Today's cafe is a "discovery" format, with hands-on participation from the audience. In this instance, we'll be taste-testing! Erica will provide some background information on feeding babies and toddlers, and recipes will be included for the foods available today. Baby food recommendations seem to be constantly evolving as our understanding of nutrition changes, and so we remind you to always check with your pediatrician before making decisions about your child's diet.

The AAP's current Infant Feeding Tips are as follows:

• Breastfeeding: ​Exclusive breastfeeding for the first year (see specific language from “Breastfeeding and the Use of Human Milk”)
• ​Bottle Feeding: Avoid bottle propping; Only breastmilk or formula in bottle unless otherwise directed by physician
• Food Introduction: ​Introduce solid foods around 6 months of age; Expose baby to a wide variety of healthy foods; Also offer a variety of textures
• Healthy Snacking: After 9 months, offer 2-3 healthy and nutritious snacks per day; Maintain fruit and vegetable consumption after finger foods are introduced
• ​Foster Self-feeding: Babies are encouraged to use spoons and fingers to feed themselves; Babies are encouraged to drink from a cup starting at 6 months of age; Parents recognize hunger and satiety cues
• Healthy Drinks: Babies should drink breastmilk or formula for the first year of life; Try to avoid introducing juice until child is a toddler. If juice is introduced, wait until 6-9 months and limit consumption to 4-6 ounces; Avoid introduction of sugar-sweetened beverages

The website Wholesome Baby Food is a great resource for new parents. There are suggestions for when and how to introduce new foods, as well as recipes and advice. When making homemade baby food, they recommend the following:

• ALWAYS consult your pediatrician prior to beginning any new food for your infant. Discuss making homemade baby food with your pediatrician. Learn more about infant feeding at the World Health Organization and the American Academy of Pediatrics websites.
• THINK about following the 4 day wait rule when introducing a new food to baby - offer your baby the same new food for 4 days to test for allergies to that food. This applies even when you are making homemade baby food. Never introduce more than 1 new food at a time when first beginning solid foods.
• ALWAYS use clean hands, clean cooking utensils, preparation surface(s), pots/pans etc when making and and preparing homemade baby food. Cleanliness and Food Safety is a MUST when making homemade baby food.
• REMEMBER that all babies are different and will not like/tolerate the same foods or food textures. DO NOT DESPAIR! You should be willing to experiment with baby solid food for your baby. Offer your baby different foods, use different ways of preparing those baby foods and be willing to have a huge store of patience.

As we begin introducing babies to solid foods, it can be difficult to know how much to feed them. Remember that breastmilk or formula should still be the main source of nutrients. The purpose of introducing solid foods before one year of age is to get baby used to new tastes, textures and consistencies of food, which will later help them develop a healthy and balanced diet.

How Much Food Should My Baby Eat?

Remember the catchy phrase, "Food Before One is Just for Fun".

It is most important to ensure that your baby is still receiving proper amounts of breast milk and/or formula. Early solid foods are meant more for practice than nutrition.

4-6 Months: Always offer solids after bottle or breast. Baby may eat anywhere from 1-3 tablespoons of food at 1 or 2 "meals"

6-8 Months: Formula and/or Breast Milk is still most important at this age and stage. Babies in this range may be just starting solids so the above for 4-6 Months would apply. Some babies may be eating up to 8 ounces of solid foods between 2-3 "meals" during a day.

8 Months and on: Many babies will be eating 3 "meals" per day at this stage; including a grain, fruit, veggie and a meat or protein source such as eggs.

-Pay attention to your baby's cues as your baby's feeding patterns will change daily and may be affected by the goings-on around him. Your baby will eat just the right amount for YOUR baby. Watch his signs for being both hungry and full.

-Pay attention to diaper output and have your child weighed regularly if you are concerned about weight gain.

How Do I Prepare Early Foods?

Mash It: Many foods can be mashed with a fork or potato masher. Foods such as ripe bananas, avocados and soft cooked foods such as sweet potato, apples or squash can all be made with a fork or potato masher. Using a fork or masher will depend on what type of texture your baby requires.

Use a Food Mill: Cut the food into pieces. Put the cooked food through the food mill. (The skin and seeds will stay in the mill.)

Chop or Grate Baby’s Food: Foods can be finely chopped or grated (with a cheese grater), then mixed with liquid. This is great for babies who are self-feeding.

Food Grinder: A food grinder can be used to grind up foods for your baby. This is a simple way to prepare meats and more textured foods. The food grinder is also great to take on vacation or when dining out with baby. You can quickly and easily grind up fresh baby food in your hotel or at the restaurant.

Blender or Food Processor: Add your cooked food to your blender or food processor and blend to the consistency your baby requires. If needed, add liquids such as breast milk, formula, water or the cooking water from the food you cooked to thin out the baby food.

Sieve or Strainer to Finish Homemade Baby Food: Many parents like to use a sieve or strainer to further thin homemade baby food. These gadgets may be particularly useful for foods that have stubborn skins, such as peas and green beans. Put the food into the sieve or strainer and push it through into a clean bowl. Repeat the process as many times as you need.

**The preferred method for cooking baby foods are steaming, baking, roasting and pressure cooking because these methods all have the least amount of nutrient loss after cooking.

Rice Cereal

You CAN skip cereals altogether if you want to. Many sources now recommend beginning a baby with fruits or an orange veggie like sweet potato as first food(s). Studies are now revealing that grains may not be good starter foods for baby to digest. Starting with a fruit like avocado or banana or a veggie like sweet potato is a great alternative to cereal(s).

There is no medical need to start baby out with cereals; unless your pediatrician has indicated your baby may need extra iron due to less than overall good health or due to being pre-term. In this instance, you should use a fortified commercial infant cereal and consult with your pediatrician on the best foods to offer as "first" foods; you may be surprised to hear your pediatrician recommend adding meat to baby's diet!

Dr. Frank Greer, from the Committee on Nutrition, American Academy of Pediatrics recently noted in an interview that "Rice cereal has traditionally been the first complementary food given to American infants, but “Complementary foods introduced to infants should be based on their nutrient requirements and the nutrient density of foods, not on traditional practices that have no scientific basis."

"Rice cereal is a less than perfect choice for the first complementary food given to infants. Rice cereal is low in protein and high in carbohydrates. It is often mixed with varying amounts of breast milk or formula. Although most brands of formula now have added iron, zinc, and vitamins, iron is poorly absorbed—only about 7.8% of intake is incorporated into red blood cells." - Read Rice Cereal Can Wait to learn about the new thinking from the AAP.

"For most babies it does not matter what the first solid foods are. By tradition, single-grain cereals are usually introduced first. However, there is no medical evidence that introducing solid foods in any particular order has an advantage for your baby." Source: 09/2008 - Starting Solid Foods (Copyright © 2008 American Academy of Pediatrics)

Always use brown rice when making homemade cereals, it's just more nutritious!

Baby Led Weaning (BLW)

Baby Led Weaning means letting your child feed themselves from the very start of weaning. The term was originally coined by Gill Rapley, a former health visitor and midwife.

**Language clarification: “Weaning” is meant in the British sense, not the American. In the UK, ‘weaning’ means ‘adding complementary foods’, whereas in the States it means ‘giving up breastfeeding’.

According to the most recent research most babies reach for food at around six months, which is also the time that mothers are being encouraged to wean* by their pediatricians, in accordance with the WHO guidelines. Baby Led Weaning (BLW) is skipping thin and runny purées and not feeding your baby with a spoon.

Baby Led Weaning means offering your baby (age appropriate) foods that are soft-cooked and cut or mashed into small easily manageable pieces. You may choose to offer your baby a large hunk of apple that she can easily hold and gnaw on or a bowl full of soft cooked mashed apples; the choice is yours. The foods are then given to your baby to eat without being pureed and without being spoonfed. You do the cooking, the cutting or mashing and the offering of the foods and your baby does the rest. It is important to note that your baby should be in control of what he is eating and you should never actually feed him by putting the foods into his mouth!

Recipes

With that advice, Erica reminds us that baby food does not have to be homemade. Give it a try, and find the balance that works for your family. Finally, recipes! Below are links to the recipes we sampled this morning.

• Tuna Cakes
• Baked Oatmeal
• Pureed Prunes
• Quick Broccoli
• Quick Eggs
• Plum Chicken
• Butternut Squash & Carrots

Café Recap: Taking Care of Mama

Our panelists: Stephanie Fournier (PT, DPT, WCS, CLT-LANA), Jilayne Luckey (PPMD Support Group Leader), Debbie Perdew (DONA) and Lisa Wixted (LLL Leader and Yoga Instructor), and our  moderator, Lauren Barnes.

Being a mother means caring for others, sometimes above yourself. Today we are talking about the importance of taking care of yourself as a mother. Below are a few difficult but necessary pieces of advice for your new role as a mother: 1. Be realistic - you have less time now that you have a baby 2. Simplify your life - focus on what is most important 3. Establish a new routine - it takes time to find a regular rhythm after having a baby 4. Ask for help - let family and friends assist you 5. Learn to let go - trying to do too much doesn't leave enough time for what's most important

Stephanie emphasizes number 3, establish a new routine. You will not be able to jump back into your former way of life like tv and media would let you think. Debbie says that simplifying your life is crucial; trying to do too much will not be in the best interest of you or your children. Jilayne says that keeping each of these items in mind will help you balance your new lifestyle. Lisa encourages asking for help and then accepting help. She knows our natural instinct is to say "oh no we're all fine", when really there are plenty of things we could use help with. Via show of hands, our audience acknowledges that we all struggle with each of these items.

Physically, our bodies have been through a lot after birth. Stephanie says that our pelvic floor muscles have been "running a 9 month marathon". During delivery they are under even more stress, and stretched up to 120%. We need to give ourselves a break and rest so that our bodies have a chance to recover.

Lisa encourages deep breathing exercises as a way of relaxation. It is a simple way to give yourself a quick few seconds of rejuvenation. Jilayne finds that remembering to stretch can feel so much better physically that it will help mentally as well. She also actively pushes the negative thoughts away, not letting herself get trapped under a messy house or other superficial worries. Our audience suggests simple things like having a snack (mamas get cranky without energy, too!); reading a non-parenting book; getting outside to let kids get out their energy and yelling; doing something that makes you feel like a person outside of being a parent; spending time with your spouse (put the baby down early and relax together).

There are many changes during pregnancy that are to be expected and many of these issues will continue 6-8 weeks postpartum. If there are still issues after 6-8 weeks postpartum, or new issues, check in with your doctor. If something doesn't feel right, don't hesitate to talk with your care provider.

How do we find time to shower and cleaning during motherhood? Debbie recommends putting infants in a safe apparatus, and teaching older children how to behave and help you around the house. They can get their own snacks, help pick up, etc. Lisa did the familiar "put the baby in the bouncer right outside the shower and play peek-a-boo while you clean off" routine. Audience members remind us that a baby crying will be okay for two more minutes while you rinse out your shampoo. Others find that they need peace in the shower and will create a new routine, or put the baby tub in the shower with them.

The following self-care tricks can help you refocus and relax: 1. Mommy Break/Mommy Time Out 2. Mom's Night 3. Pamper Yourself 4. Relax

Exercise can be a challenge for mothers. Finding time to work out is not easy, but Lisa suggests getting your kids involved. Wear a baby sling and do simple toe-raises or squats. Mommy and Me Yoga incorporates moms and children working out together. Stephanie says to do kegals, tightening your pelvic floor muscles. To do it correctly: breathe, don't use your butt muscles, don't bring your knees together, and squeeze gently. Do kegals when nursing, before standing up and while sitting down, and as often as possible during the day. Make an effort to keep your posture correct throughout the day as well. Don't bend at the waist and hunch over to pick up kids' toys; instead, sit on a stool and keep your posture upright or squat (if your body is ready).

Debbie suggests living room dance parties as a way of exercise- kids love it! Try sit ups with a baby on top of you, push ups with a baby on the floor, etc. Stephanie cautions that if we have diastasis (splitting of the ab muscles), we need to be careful about the exercises we do. When the ab muscles separate during pregnancy (normal in the 3rd trimester) they sometimes come back together naturally after birth but other times require special steps to recover. If you do situps and see a little bump in your abs, you have diastasis and should see a physical therapist.

Neck and shoulder pain are also common postpartum; because of the way our weight is distributed during pregnancy, our posture suffers. If you don't take care to actively work on your posture after birth, then neck, shoulder, back and wrist pain are likely. Using good posture when nursing and feeding baby is important: put a small pillow behind your back (lumbar spine); add a boppy or nursing pillow to your lap (bringing the baby up instead of slumping down to meet him); roll your shoulders up and back, then down; and finally, bring your chin up and back instead of tucking it down.

In preparation for your first child, here are some suggestions to get yourself ready mentally: 1. Learn as much as you can 2. Talk to people you trust 3. Think positive 4. Don't be afraid to ask for help

Remember, mamas, that by taking care of yourself you can take care of your children. Set the example of living a healthy, balanced lifestyle and your children will learn to do the same.

Café Recap: Babywearing

Our moderator and panelist: Erica Wolfe (wearing a Ring Sling above)

Erica welcomes and encourages mothers who love babywearing and want to learn more, those who have never heard of it, and those who know it is not for them. Strollers are great! ;)

One of the main benefits of babywearing is convenience. Being hands-free and keeping your baby close is very helpful. You can get things done while still nurturing and comforting your baby. If you need further convincing, the article Ten Reasons to Wear your Baby, by Laura Simeon, MA, MLIS, lists several more benefits!

The most important aspect of babywearing is safety. Always be aware of baby's position and that their airway is clear for breathing. Use the same safety measures you would when carrying your baby in your arms. When back-carrying, always stay aware of baby's movements and check them in a mirror periodically to ensure they are safe and comfortable. Erica reminds us: do not do something that you don't feel comfortable doing. If you're not ready to back-carry, then don't. Wait until you can get a spotter or a support person to ensure the safety of your baby. There are online groups and resources (both local and international) where you can get feedback and information on how to safely wear your child. For more excellent information on babywearing safety, see Earthy Crunchy Mama.

Another safety reminder is TICKS:

TIGHT

IN VIEW AT ALL TIMES

CLOSE ENOUGH TO KISS

KEEP CHIN OFF THE CHEST

SUPPORTED BACK

Types of Carriers

Wraps - the most basic and sometimes most complicated of baby carriers. A wrap is just a long piece of fabric, ranging from a long towel to a $1000 hand-dyed piece of fabric. There are both stretchy and woven wraps. Stretchy wraps are 100% cotton knit fabric. Stretchy carriers are most comfortable for young babies under 20 lbs. Stretchy wraps are ONLY to be used for front carries (back carries with a stretchy wrap are not safe). A woven wrap (seen above) is supportive and versatile, though does require a bit of skill to use. They come in a wide variety of lengths, and front, side and back carries are all possible. A size 5 or 6 is a common beginner size that will give you a wide availability of carries. Woven wraps are made of cotton, linen, hemp, wool, silk and various blends of each of these. Woven Wrap Sizing - Size 1: 2.2 meters (also referred to as a rebozo length or shorty) - Size 2: 2.7 meters (also referred to as a rebozo length or shorty) - Size 3: 3.2 meters (also referred to as a long shorty) - Size 4: 3.7 meters - Size 5: 4.2 meters - Size 6: 4.7 meters (common beginner size, “standard”) - Size 7: 5.2 meters

Mei Tais - ("may ties") is a popular Asian carrier (seen above). It is a basic design consisting of a square or rectangular piece of fabric with 4 straps. Like a Soft-Structured Carrier (see below), but without the buckles. Can be used for front, side and back carries, and used for newborn through toddler aged children.

Ring Slings - a single piece of fabric with a hemmed shoulder and two rings, worn on either shoulder. Many ring slings are made from woven wraps, and come  in a variety of fabrics. Thin fabrics are not as supportive for toddlers, and the way you hold the child in a sling is not evenly distributed which can be difficult after extended periods. Ring slings are convenient for newborns and you can easily breastfeed a child in a ring sling.

Soft-Structured Carriers - sometimes called "backpack carriers", this carrier has padded straps and buckles. They can be worn in back or front. Less difficult to learn than a wrap, they are easy to get on and into position. While men can wear any carrier, most prefer a soft-structured carrier. When selecting this type of carrier, select a wide base to support your baby's bottom (this keeps their weight from being too heavy on their hips/legs). These carriers often include an insert for carrying newborns and small babies, though your child may be more comfortable in this type of carrier once they have better head control.

Toddler carriers - many brands make toddler-sized carriers, if you feel your child is outgrowing your wraps and slings.

Wrap Conversions - these styles have been created with woven wraps (as mentioned above in Ring Slings). They are very customizable, but can be expensive. If you have a woven wrap that you love but your child no longer wants to be wrapped, you can have it converted to another style (like a Mei Tai, etc.). There are a plethora of acronyms in babywearing, but those that start with WC indicate a Wrap Conversion.

Where to buy new carriers:

- Abby's Lane - Birdie's Room - Marsupial Mamas - Mom's Milk Boutique - Pax Baby - Specific brand pages

Where to buy used carriers:

- The Babywearing Swap on Facebook - Babywearing on a Budget (under $100) on Facebook - TheBabywearer.com (account required)

Local Babywearing Groups:

- Babywearers of Lynchburg - Roanoke Babywearers - Blue Ridge Babywearers

Online Resources:

- TheBabywearer.com - Create a free account and gain access to tons of babywearing resouces, forums, details on all carriers, geeky threads about brands, and B/S/T boards. - Babywearing 102 - Babywearing 102 on Pinterest - DIY Babywearing

For even more detail, view Erica's babywearing notes here.

Photos by Liz Cook of Sincerely, Liz, Inc.

Café Express Recap: Babywearing

I had such a great time introducing babywearing basics at Café Express, and we got to try lots of different types of carriers!

We promised to send some links to babywearing resources. This is only scratching the surface, but here are a few things to look up!

Local community:

Babywearers of Lynchburg have regular meetups and playdates and are a great way to try something out before you buy! Plus, there’s a lending library that’s gradually expanding, so you can test things out at home, too.

If you live closer to Roanoke or Charlottesville, there are groups in those cities that meet regularly, too.

Safety Basics:

The T.I.C.K.S. reminders from The School of Babywearing.

Optimal Positioning Infographic from Babywearing International

Where to buy wraps and carriers:

Unfortunately, there’s not a place locally to buy brand new, and only a limited selection end up at Once Upon a Child or Kidz Kraze. However, there are SO many reputable retail stores online. We don’t endorse any particular store, but you could start with Birdie’s Room, Abby’s Lane (located here in Virginia!), or Marsupial Mamas, to name a few.

You may have heard me refer to some online swaps: the “big swap” is Facebook’s Babywearing B/S/T (no price limits), and there’s also Babywearing on a Budget (everything must be under $100). Some tips: Read all of the rules first, and take time to learn the shorthand. As with any online peer-to-peer marketplace, there can be risks, but if you look at feedback and as questions, you can find some great things to try. On the big swap, don’t be surprised if some things are listed for more than $150 — remember most of these items will hold much of their value if well cared for, and pricing comments or criticism are not allowed on the swap.

Online communities:

There are all kinds on Facebook: groups for handwoven wrap lovers or fans of particular brands, local groups, babywearers of diversity, and the list goes on! Babywearing 102 has been a good place to learn, with a lot of documents with resources. However, it’s exploded with growth and can have the drama that comes with lots of strangers hanging out in the same place! TheBabywearer.com (self-described as “premier internet forum dedicated to babywearing”) is a long-established group, but the forums are hosted within their website, not on Facebook.

If you have questions about what you heard on Saturday, don’t hesitate to ask.

And remember: we support and encourage each other, whether we fall down the rabbit hole of babywearing, or decide to forget all the fabric and enjoy our strollers!

Cafe Recap: Toys & Technology

Panelists: Maria Hayden and Jessica Reagan, and our moderator, Lauren Barnes.

We recently had a Cafe about playtime and creative parenting that focused on non-media related activities. The goal for today's mom-to-mom panel is to get the conversation going around technology...not to bash or applaud one way of parenting, but simply to provide you with resources, ideas and different perspectives.

The AAP suggests that "Children and teens should engage with entertainment media for no more than one or two hours per day, and that should be high-quality content. It is important for kids to spend time on outdoor play, reading, hobbies, and using their imaginations in free play. Television and other entertainment media should be avoided for infants and children under age 2. A child's brain develops rapidly during these first years, and young children learn best by interacting with people, not screens." Jess agrees with this guideline but it is not a hard and fast rule in her house. She finds that having a strict rule is unproductive but she does generally limit screen time for her kids.

One study suggests taping tv shows so that you can pause and discuss the content of the show as a family when pertinent. Maria's family has a weekly dinner and a movie tradition. She finds herself screening movies before introducing them to her two-year-old, and seeing them through new eyes as a mother. She also suggests Netflix for finding content that is easy to pause and discuss.

Jess does not have limits on TV usage, in an attempt to keep TV from becoming something that her children covet and see as the ultimate treat. She has reached a point that her children will watch a little bit of TV when they want to, and then after a little bit they decide they are done and move on to something else. At one point she found her family watching more TV than desirable, so she put a blanket over the TV and said it was resting. Her kids adorably ask if the TV is sleeping, but it is not something that has become a battle in her house. She thinks that by allowing them some control over their TV time she has decreased the value of television.

TV can be used as a tool for educational purposes as well. Lauren's child was excited to see winter sports on YouTube during the excitement of the Olympics, and since these sports are not available locally it was an opportunity to learn about them. Some suggestions for getting the most out of TV:

• Look for programs, specials, documentaries, etc that explore areas of interest to him/her.
• Use events in the news and subjects of fictitious programs as springboards for discussion.
• Encourage your youngster to broaden her horizons by watching programs that transport her to other times and places, or that expose her to different perspectives or philosophies.

Some favorite TV shows from our audience members: Doozers (Hulu), Dinosaur Train (PBS), Magic School Bus (Netflix), Word Girl (Netflix), Daniel Tiger, Clifford, and Sesame Street (Netflix and Amazon).

Some parents use Facetime to give grandparents and family members that live far away the opportunity to see and interact with the baby. Both of our panelists used the term "survival mode" as a time that they use TV to keep their own sanity and take a needed break.

Jess knows that her children will be exposed to and involved in media and the online community, and she wants to be the one to introduce it to them. Fighting social media is a futile battle, so she wants to educate her children on how to use it responsibly when they reach an appropriate age.

Educational apps and tools can help us make the most of the limited screen time that our children are exposed to. Some examples include sign language apps and personal care apps (bath time, potty training) . Many phones have child locks that either keep your child locked inside an app (so they don't have access to the rest of your phone), and/or allow them to only access specific parts of the screen. Educational app resources:

• Our favorite - you can seach by age, device and price! - Kindertown
• Parents Magazine
• Family Education
• Common Sense Media: Guidelines
• Common Sense Media: Kids' Apps

With the holidays approaching, we wanted to gather some ideas for children's gifts. Some of Lauren's favorites for her daughter, as well as suggestions from audience members include: costumes, puzzles, books, dolls, art supplies, memberships (museums, etc.), blocks. More gift guides and ideas:

• The Imagination Tree: Toys for Babies & Toddlers
• The Imagination Tree: Toys for 2-6 Year Olds

Further resources for study: This article in Pediatrics Journal describes the impact of TV on young children's development. The AAP shares this article on Media and Children.

Cafe Recap: Postpartum Body Image

Our panelists: Kirstin Magnuson (Therapist and Mama) and Jill Stroud (Personal Trainer and Mama), and our moderator, Lauren Barnes.

This morning’s discussion can be an extremely touchy topic and could easily be full of judgment and eye rolling...our goal is to have an honest and kind conversation. We hope we can all accept that we each view our bodies differently and that we each come into this discussion with our own views of health, image, insecurities, and perceptions. This is not a conversation that will “fix” anything. Instead, it is simply the start of a conversation that alerts us all to the fact that we might need to pause before we assume.

Our first question is for the audience. When asked how they would describe their bodies, in one word, BEFORE they had children, here were some of the responses: awesome, free-of-stretch-marks, healthy, strong, tan, energized, less gravitational pull, and fertile.

Kirstin was warned by “helpful” strangers and acquaintances about the horrors of a postpartum body while she was pregnant. Her friends approached the subject with more love while remaining honest. Jill did not know what to expect from her body, and was surprised by how out of control she felt. She felt additional pressure about her body as a trainer because of how she was on display in her career. The usual methods she would have used for weight loss (cutting calories, increasing workout intensity) were not always an option during and after pregnancy. So many factors (breastfeeding, lack of sleep and energy, etc.) are involved in the changes in your body and how you can get back into shape.

Why are we insecure about our bodies and why do we compare ourselves as women? Kirstin says that the inundation of “perfection” in models and in the media make us feel that that is normal, and that our own bodies are somehow wrong. Jill says that usually our expectations are unrealistic. She said that while some women can “snap back” and get back into shape quickly, that is not the norm for everyone. Comparing ourselves to others makes our own journey harder.

As an audience so many of us have had insensitive comments made about our bodies after having children. We have been asked if we're pregnant when we're not, or heard snarky comments about remaining baby weight. We've been told that our expectations are too high or that we're somehow selfish for wanting to get back to a healthy and active lifestyle postpartum.

Jill says the keyword is healthy, and that does not look the same for everyone. So often our goal is thin or sexy instead of a healthy body. Thin does not mean healthy, there is often a lack of muscle mass after pregnancy that is not healthy even if you can fit back into your pre-pregnancy clothes. While Kirstin didn't have trouble losing weight, she found that she was out of shape and didn't like it. She was easily winded and sore, and found that being more active let her feel better about herself regardless of how she looked.

So often on social media we only see the success stories. When we're proud of our bodies we want to share it, but doing so can be damaging to others who haven't had the same success. We should all be proud of these strong bodies who have nurtured and labored and birthed these children. One audience member reminds us that we can choose what we see on social media and the internet. We can block or unfollow or choose to ignore those who are damaging to us. She has found several groups and individuals to follow who are encouraging and uplifting, some of whom are in great shape and serve as positive inspiration without bringing her down emotionally. It is your choice to join a group that is supportive for you and your needs. Even well-meaning mothers can make us feel down, especially from a person that you expect support from. Generational differences can make it difficult for older women to support us in new and conventional maternity clothing and postpartum experiences.

From our husbands, we get various responses and methods of support. Some stories: one mama's husband brought her the same shirt in every size postpartum, while another's took her to buy bigger pants with nothing but joy and support. One dear husband makes brownies when his wife is upset, which is so sweet but really not helping her postpartum body insecurities.

Jill says that the best way to get back into shape after birth is strength training. High intensity strength training and setting strength goals is very effective. Picking a goal that is not a number on the scale or a jean size will help you to get to healthy place. Instead of the outcome, she recommends focusing on the process. As you meet and move on to different goals, you will eventually get to your desired outcome but in a healthy and natural way. For breastfeeding mothers she recommends listening to your body (and your baby!) and eating enough to keep your body energized. Staying hydrated and keeping your body nourished will help allow you to maintain your breast milk supply, as long as your workout is moderate and reasonable.

Lauren questions whether our true measure of beauty should be our outward appearance or our inner selves. Kirstin tells a story about a time that her child waited patiently while she had an adult conversation, and she recognized that she would like to achieve that patience too. That is how she would like to be recognized and seen as beautiful, for her heart and her person. Jill points out that we do this to children too, telling them how cute or beautiful they are, as opposed to pointing out a great personality trait or behavior. The mother of some attractive children would reply to these “you're so beautiful” complements with “but what's in your heart?” to remind children that looks are not what matters. What moms do want to be complemented on: our work accomplishments, our efforts as mothers, and the ways we give of ourselves. One audience member sees unshowered mothers as beautiful, because she knows that the sacrifice of a shower was made so that a baby would not be left crying. One grandmother knows that just being pregnant, giving birth or having a newborn would each be a feat on their own, and yet we do all three without a break; she reminds mothers to be kind to themselves. She also says we have progress days and maintenance days, and some days are just survival days. Appreciate each of these days and know that they are all for a reason and purpose.

Some strengths we have gained since having children: patience, fearlessness, responsibility, endurance, and capability. Please feel free to share some of your postpartum experiences, good and bad, in the comments.

Cafe Recap: Creative Parenting

Panelists: Josie Olson (Registered Play Therapist and Mama) and Madie Haskell (Early Childhood Education Professor, Mama and Grandma), and our moderator, Lauren Barnes.

We will spend the morning discussing some creative ways parents can encourage children to regulate their emotions, utilize problem-solving skills, encourage mindfulness, and deal with that o-so-scary temper tantrum. The goal for this cafe topic is to get conversation going about parenting and to provide you with resources, ideas, and hopefully some refreshing perspectives.

Problem solving skills can be gained through play, says Josie. Adapting to and interacting with their environment can nurture these skills. If safety is not an issue, she recommends letting children work through problems themselves. Madie agrees and adds a reminder that there are very few things in a toddler's life that they are in control of. If you can add things to their lives that they can control, this will teach them responsibility and problem solving. Giving them the opportunity to help solve situations by asking questions ("What's going on here?") will be more beneficial than simply telling them the solution. She stresses that problem solving is key to emotional and social well being, which can help them be successful in life.

Josie says that mindfulness can be promoted by tracking a child's behaviors (by narrating aloud), and making suggestions when they could use some help. Explaining what you're doing as you do it (while cooking in the kitchen, for example) will help them see that what you're doing has a purpose. In terms of milestones, Madie says that there is not a specific time at which children should be learning certain responsibilities. There is a guideline (link), but it is not rigid.  Karen Ruskin, the author of The 9 Key Techniques for Raising Respectful Children Who Make Responsible Choices, suggests these steps: 1. Start young 2. Let them help you 3. Show kids the way 4. Model responsibility 5. Praise them 6. Manage your expectations 7. Avoid rewards 8. Provide structure and routine 9. Teach consquences

Many of these ideas mimic the Montessori way of teaching, through play-based learning and allowing children to help with real life tasks. Josie reiterates that modeling for children will let them learn. She suggests child-sized tools (brooms, gardening tools, etc.) to let children help around the house. Madie warns against rewards for expected responsibilities, but a spontaneous good deed or surprise is fun and beneficial. Our audience questions how to teach consequences, and Josie suggests the book Have a New Kid by Friday. Madie says the hardest part of teaching consequences is the parent; we naturally want to give in and see our children be happy. Following through with consequences is not the path of least resistance, and sometimes we as parents do give in (and that's okay!). An audience member acknowledges that she knows consistency is key, but it is hard to do. A funny tool called the Dammit Doll can help parents release frustration (out of sight of children, of course).

Teaching empathy to a child can be challenging. Josie suggests being an example for your child and treating those who are different with respect and humanity. Doing charitable acts, helping others and being kind to someone in a difficult situation shows your child how to respond in the world. Filial Therapy including expressive arts, directed drawing and more (coming up with a family crest or moto, for example) can give insight into the family relationship.

When it comes to play, Madie recommends watching children play without interruption (our tendency is to control or direct them), as independent play is vital for children. Playing with adults includes doing everyday tasks together (walking together to get the mail) and is also very beneficial for children by helping them understand the world around them. Cooking is a great way to play with children, and can help promote good eating habits. Parents benefit from this play, too! Our audience members mentioned that sometimes kids want parents to "play" with them, but then they ignore you. Madie says this is normal and just being available is good. She suggests introducing a new toy (or unusual household item or tool) every month or so to keep kids interested and learning new things.

Regulating emotions can be done through expressive arts (having children draw a picture of their feelings), asking how they feel (as opposed to telling them), using stress balls, inflating balloons to practice/mimic breathing, molding clay (pound it if you're angry, etc.). The goal is to allow them to realize that all feelings are okay, but all actions are not. We want to give them an appropriate outlet for their feelings and emotions. Lauren suggests introducing these stress management tools when they are not in the throes of an emotional meltdown, so that they will know how to use them when they are needed. Books may not be helpful during a meltdown, but using a book afterwords to open a discussion about what they were feeling is very helpful. Modeling all of the different emotions as a family (again, not during a heated moment), is a helpful tool as well. Talking through our own emotions as parents is a good example of showing how to handle strong emotions and allowing children to understand that everyone has these feelings.

One parent mentioned the need for her child to be productive despite sad or unpleasant feelings. Our panelists suggest that acknowledging their feelings and then setting a limit (a timer or activity) can be a compromise. Madie says to always use positive feedback when discussing feelings ("I appreciate that you are feeling sad. It is very sweet that you're missing Daddy.")

Why do temper tantrums happen??! Reasons include a battle for independence, limited skills to influence the events in their lives, inconsistency and unrealistic expectations, undue strictness, over-protectiveness, overindulgence, and lack of assertive limit setting. Conscious discipline is one method (there are many!) for dealing with a child's undesirable behavior. The STAR method  (Smile, Take a breath, And Relax) is mentioned in this video from ConsciousDiscipline.com, which discusses reasons and methods for dealing with temper tantrums.

For children who are easily frustrated and want to give up on tasks, emphasizing effort as opposed to the outcome can help children's self-esteem. Congratulate a child's effort and encourage practice to build tenacity and a willingness to continue trying even after failure. Give reminders of other skills they have mastered to show them that they are making progress.

Madie has helpfully provided a slideshow covering many of the topics discussed today. Click here to download the Power Point presentation.

Cafe Recap: Girlfriend’s Guide to Postpartum

Our panelists: Jilayne Luckey (Mama and PPMD Support Group Leader), Nycole Fox Formo (Mama and PPMD Support Group Leader), Julie Brown (Mama and RN), and Danielle Hunter (Mama), and our moderator, Lauren Barnes.

Childbirth is very intense physically on our bodies. Six weeks is the typical time for a postpartum followup appointment with your OB or Midwife. At this point most women are told that they can resume their everyday lifestyle, with the exception of very strenuous exercise. In reality, our audience felt that it took about 2 months or more before they felt normal again vaginally. Another unexpected postpartum symptom: night sweats. The hormones in our body cause many women to wake up completely sweaty during the night. Keep a towel or change of clothes nearby!

In terms of breastfeeding, our bodies go through several stages. Julie explains that when the placenta is delivered the body starts producing colostrum (a yellow, nutrient-rich milk). Even without feeling full, it is very important to nurse at this point as it will help increase your milk supply. A few days after birth (up to about 5-6 days with a C-section), your milk will come in and your breasts will feel full and heavy (sometimes engorged). It is totally normal to be confused or unsure about your milk and whether it has come in or not. Contact a lactation consultant for reassurance or help with breastfeeding.

Jilayne advises to keep in mind that even after several pregnancies, there can be physical symptoms you're unprepared for after birth. Some experienced mothers are met with the attitude that they know what they're doing and don't need help. With several children to care for, this is not true! Each child and birth are unique and bring their own challenges. Danielle was surprised that the recovery with her second birth was so much different than with her first.

Changes in appetite, hair loss, continually sore joints, mood swings, several weeks of spotting or bleeding, and strange dreams are other normal physical symptoms of the postpartum period.

Emotionally, there may be several hardships to overcome. Many women do not feel the immediate bond with their newborn that they expect. Nycole talks of the vulnerability that you are exposed to by the tremendous feelings you have for your child. Expectations can be hard to overcome if things do not go as you think they will. Babies can be very unpredictable and this is hard for some women who like to be in control. Reaction versus response is an important distinction. If you can accept your reaction you will have a better time responding appropriately to your child's needs.

The birth of Jilayne's third child, her son, was very difficult emotionally for her. Much of the first three months she does not remember, as she was struggling. At about three months postpartum her husband recognized her depression and acknowledgement of this was huge for her. She found herself acting in ways that she didn't want to, yelling at her children more than necessary, but she couldn't find the strength or grace to handle the situation as well as she wanted to. She bonded well with her son, but felt that she had no right asking for help since she had wanted this child and brought this upon herself. Her advice is to please remember that your are the best mom for your child, and there is no shame in asking for help (no matter how many children you have!).

Danielle was expecting her newborn to be the struggle, but instead found that her preschool daughter was the one exhausting her emotionally and physically. Asking for help with older children can be very important in allowing you to care and bond with your newborn.

Julie says to give yourself a head start with breastfeeding, take a local class and educate yourself as much as possible. Read, talk to other mothers and be aware of any potential problems or hardships. Mastitis, thrush, an incorrect latch, supply issues and more can all make breastfeeding more difficult. Learning proper breastfeeding positions, especially for newborns, is important for breastfeeding success as well. Follow this link for a video that gives instruction on hand expression, a helpful technique for new breastfeeding mothers. Another resources is La Leche League (local link). Also keep in mind that breastfeeding can be difficult physically and emotionally even if everything goes well. The first few days after birth are difficult and it is normal to feel overwhelmed with breastfeeding and other parenting issues.

Julie recommends the following local resources for postpartum breastfeeding help: VBH has lactation support 7 days a week. You can request an LC to come see you. Centra's Lactation Warm Line: 434-401-9344 (outpatient) Centra's Baby Cafe: every Tuesday and Thursday from 10-12 noon in the Center for Family and Childbirth Education. (Outpatient). Central Virginia Lactation Consultants: (Lisa Settje) 434-239-2852 Best Start: (Jane Bradshaw) 434-384-6262 La Leche League:(Lisa:434-316-6040; Catherine:434-229-0852) Kellymom.com

On the other hand, formula feeding can also be difficult for mothers emotionally. Sometimes a mother wishes to breastfeed, but is unable to for whatever reason. Remember that doing what is best for your baby is what is important, and try not to let yourself listen to those who don't support your decisions. Find a support system that is positive and will help you move forward with the best choices for your newborn.

Being aware of resources for grief, breastfeeding and other postpartum issues ahead of time can help you choose those resources if you need them later. Educate yourself to the issues and the possible outcomes of your birth, be honest with yourself, and get help however you need it. Nycole suggests the book Raising An Emotionally Intelligent Child.

Café Recap: Adoption

Panelists: Jackie Gordon (Adoptive Mama), Patricia Coleman (Adoptive Mama), Kirstin Magnuson (Licensed Therapist) and our moderator, Erica Wolfe. Let's start with some stories about the adoption process. Jackie always wanted a large family, but did not know that adoption would be part of her story. After an injury during her second child's birth, she was no longer able to have biological children. This led she and her husband to the decision to adopt, specifically an international adoption from China. The process for their first adoption took about three years, plus another year of post-placement check-ups and paperwork. Their second adoption was through Living Hope and The Waiting Child Program, which includes children that China considers "special needs".  Despite financial concerns, they decided to go through with a second adoption within two years of their first. Their first child was a year old when she was adopted, and their second child was four by the time they were able to bring him home. The adoption of Jackie's third child was several years later, at a time when they were not actively pursuing adoption. A friend reached out to her about an unborn child in need of adoption, so they agreed to meet the local couple. Jackie had huge reservations about an open adoption, but upon meeting the couple they decided to go through with the adoption.

Patricia has two adopted children, age 2 1/2 and six months. After trying for several years to get pregnant, Patricia and her husband began the adoption process. They wanted to adopt a baby and began researching. Their research led them to the local group Family Life Services. It took them two months to complete the paperwork, and then they began the wait. After seven months they were pursued by a couple and met them for an interview. They were soon thrilled to learn that they had been chosen by the couple to adopt their daughter. In the state of Virginia birth parents have ten days after the birth of their child to change their minds about adoption. Their daughter was put in foster care for the first days of her life, until paperwork and decisions were final. Although at first hesitant about an open adoption, Patricia is now very close to her child's biological parents and meets with them regularly. With her second adoption, they used the same agency.  After a two month wait, they were chosen to adopt a baby in the NICU in a closed adoption. In a rapid succession of events, they quickly named their daughter and were soon taking her home.

An audience member asked about how adoptive children feel in their family. Jackie's children have always known they were adopted, but not expressed any feelings of inadequacy within the family. Erica asked about how to bring new children into the family. Kirsten feels that as much information and background about the child you know, the better. Being structured and having a reliable routine can help the process go smoothly.

For those in the waiting process, Patricia recommends filling your lives and not focusing on the waiting. Another adoptive mother in the audience has found that the waiting process is the biggest test of yourself. Know that this is a growing period and that the wait will end and the reward will be more than worth it.

Things that you should not say or do to adoptive families: - "Why do you want more children?" - "Are they real siblings?" - A sense of entitlement about your child's history - Showing an interest without knowing how to express it appropriately - Pretty much any use of the term "real" - "You're taking the easy way out by adopting" - "You're going to adopt and then get pregnant" - "I want to adopt one day but I want to have my own first"

How you should ask about adoption: show a genuine interest and desire to have an actual conversation about adoption.

One of the hardest parts of adoption: paperwork. You will also field very personal questions from your case worker. Knowing that your adoption could fall through is very hard emotionally. The waiting period during the ten days after birth is excruciating.

Some final words of encouragement from our panelists: never let finances stop you. Adoption is a very expensive process but there is fundraising, grants, loans and other help available. Twenty thousand dollars is a modest estimate for adoption costs in our area.

Patricia's blog about adoption can be found here: addingpiecesofthepuzzle.blogspot.com

Café Recap: How to Write a Birth Plan

Panelists: Katie Page (Certified Nurse Midwife and Mama), Brenda Osterhus (Childbirth and Family Education Manager at Centra and Mama), Danielle Hunter (Mama and Birth Plan User), and our moderator Erica Wolfe.

We often field questions about birth plans in our small groups and online community.  Last year was the first time we had an entire Café devoted to the topic and when we surveyed our mamas, it was listed as one of their favorite Cafés.  So today we’re excited to again devote an entire panel to writing a birth plan! Our panelists include a care provider, a hospital representative and a mama who very recently wrote (and used!) a birth plan.  Here are their thoughts on what topics should be addressed, how to word things and how birth plans are received by your care providers.

First of all, what is a Birth Plan? Katie tells us that the history of birth plans is ambiguous, but they likely first appeared when alternatives to standard hospital procedures became more prevalent. The idea that each pregnancy and birth is not the same and therefore should not all be handled in the same way was a catalyst in the rise in popularity of birth plans. The process of creating a birth plan forces a family to consider various labor events and how they would like to handle them. A birth plan is the start of a conversation, deciding with your partner and your medical support team what the best choices are for you during labor.

Brenda tells us that the goal of a birth plan is to let your care providers know what your choices and decisions are. This is especially helpful when nurses and doctors rotate during your delivery. It is also an opportunity to make sure, well before labor, that you and your care provider are on the same page. It is a way to educate yourself about the choices and decisions you can make about your birth. Nurses and doctors are people too, and will each have their own ideas about how birth should go. It is important that your opinion is known to them, so that you will get the treatment you desire.

Danielle was lucky enough to have her care provider deliver both of her children, but this is not usually the case. A birth plan gives you the opportunity to do your research and decide what your priorities are. She says that not having expectations for how her birth will go keeps her flexible. She keeps an open mind so that she will be able to handle any unforeseen circumstances and take them in stride. A conversation with her midwife about her birth plan allowed her to remove some items that were unnecessary (like procedures that are not standard in our hospital). Sample birth plans and templates are available online (some here, here and here on our website).

Audience members shared both positive and negative experiences approaching their care providers about birth plans. One mama was nervous to approach her OB about a VBAC, but was met with his approval and willingness to work toward that goal with her. Another mama tried to broach the subject with her provider, but it was dismissed as something she didn't need to do. Her lack of education at the time robbed her of the confidence to push the subject although it was important to her.

Top Ten DOs for Writing Your Birth Plan: Tips from an L&D Nurse (from the blog Nursing Birth) #1 DO keep your Birth Plan short, simple, and easy to understand (1-2 pages max). Bullet points are fine! #2 DO keep the language of your Birth Plan assertive and clear. #3 DO use your Birth Plan as an impetus for doing your own personal research about your preferences for childbirth. #4 DO include your fears, concerns, and helpful things for the nurse to know. #5 DO review your Birth Plan with your birth attendant and ask him/her to sign off that he/she read and understands it. (Signing may be unnecessary and could even imply a lack of trust in  your care provider in some situations.) #6 DO make your Birth Plan personal (don’t just copy/paste) and DO make sure that you understand and can elaborate on everything in the Birth Plan if asked. #7 DO look at examples of great Birth Plans online to get some ideas. #8 DO run through scenarios in your mind about how labor could unfold and actually talk these scenarios out with your labor companions and doula (or perhaps even your childbirth educator or birth attendant too!) #9 DO try to treat researching and Birth Plan writing as a fun and exciting experience, not a chore! #10 DO remember to bring your Birth Plan to the hospital!!

Another positive result of a birth plan is having your choices in writing. If you decide during labor to veer away from your birth plan, your care providers and labor support can remind you of your initial intentions and help you either stay on track or choose a new path for your labor. It is also worth noting that birth plans are not just for natural births. Whatever your intentions, it is important for your labor team to know them.

After care is an aspect of labor that is often overlooked. These choices can also be included in your birth plan and will make your decisions much easier during your recovery time. Have your pediatrician lined up and ensure that they are on board with your choices for newborn procedures. Keeping your partner on board and informed about all of your choices will also help ensure that things go as planned.